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Types of Allergies

Allergies exist in many different forms. Find out more about the allergy you suffer from:

Cockroach Allergy

Cockroach Allergy Information

Many houses have dust that contains parts of cockroaches. This is most common in older, multifamily housing and in the southern United States where complete extermination of cockroaches is very difficult. Individuals with an allergy to cockroach protein, particularly those with asthma, tend to have increased symptoms if they live in such houses.

You do not have to actually see cockroaches to have cockroach allergy symptoms. The allergen is derived from saliva, fecal material, secretions, skin casts, and body parts. It is usually at the highest levels in kitchens, but may be found throughout the home, including the bedroom and bed. The levels in bedrooms may be most associated with allergic disease. They are often found in schools and commercial buildings. Cockroaches require food and moisture to survive, so eliminating sources of each can help reduce exposure.

Many people recognize allergy symptoms such as a runny or stuffy nose, itchy, watery eyes and sneezing (allergic rhinoconjunctivitis) from dust exposure related to common household chores such as vacuuming, sweeping, and dusting. House dust exposure can also trigger asthma symptoms such as wheezing, coughing, chest tightness and shortness of breath.

Drug Allergies

Drug Reactions and Drug Allergies

Most people have had trouble with one drug or another. Some drugs can cause an upset stomach or drowsiness. Some drugs can threaten our lives. Drugs put more than 2 million people into the hospital every year. Drugs cause more than 100,000 deaths every year. The number of serious drug reactions goes up every year.

A drug reaction is a problem caused by a drug that was not expected. Any prescription, non-prescription drug or supplement can cause a problem. Rarely, the immune system may react to a drug or to a chemical that your body created from that drug. This type of reaction is an allergic drug reaction.

Drug allergy symptoms

Allergic drug reactions may cause:

Skin rash or hives
Itchy skin
Wheezing or other breathing problems
Swelling of body parts
Anaphylaxis, a life-threatening allergic reaction

Reactions can occur in any part of your body.

A "pseudoallergic" or "anaphylactoid" drug reaction looks like an allergic drug reaction, but it is not allergic. This type of reaction can happen when you take the drug for the first time. This can occur with contrast or dyes used in various radiographic procedures, as well as other drugs.

Drug allergy treatment

For a mild reaction, you may only have to stop the drug.

For a more serious allergic drug reaction that is not life-threatening, treatment may include:

An antihistamine (to counteract the histamine released into your body during the reaction)

A non-steroidal anti-inflammatory drug or a corticosteroid (to reduce inflammation)

What causes a drug allergy?

Any person can get an allergic drug reaction to any drug. Allergic drug reactions are less common than other types of drug reactions. Drug allergies often arise from new chemicals formed when your body breaks down the drug in question.

For a drug allergy to happen, the drug in question or something similar must have been taken before. Drug allergies can disappear over time and some reactions that look like a drug allergy, may not be a true drug allergy.

Having a family member who had a drug allergy, makes more likely to have a drug allergy, but it does not make it more likely that you will be also allergic to the same drug in question.

Penicillin causes many allergic drug reactions. If you react to penicillin, then you may not react to related drugs. This is true for drugs with a very different chemical make-up.

Sulfa containing antibiotics may cause allergic drug reactions. There are many non-antibiotic sulfa containing drugs. Most people with a sulfa antibiotic drug allergy do not suffer allergy to the non-antibiotic sulfa drugs.

Diagnosing drug allergies

Drug reactions can be hard to diagnose. They can look like other diseases. Many of the drug reactions are known., however many have not been identified yet.

It is important to figure out if the reaction you suffered is allergic or not allergic.

When you come for evaluation for drug allergies, you can help if you take with you the following information:

When did you take the drug
When did you stop the drug
When did you problem begin
What happened to you
How long did your problem last
What other prescription drugs did you take
What other non-prescription drugs
What health foods did you take
What herbs did you take
What minerals did you take
What are the exact names
What treatments did you get for the reaction

You should bring with you:

Your usual medicines
Your other drug reactions
Your medical and surgical problems
Problems that run in your family

Bring the exact name for all of your drugs. If you can, bring the suspected drug with you.

Drug challenge tests can be helpful. For a drug challenge, you take the drug and you doctor observes your reaction. If you had a serious reaction, drug challenge can be too dangerous. Drug challenge may be the best type of testing if there is no other drug to save your life. These tests are typically conducted in a controlled setting such as in the Intensive care unit in a hospital. Given the nature of drug allergies, blood tests are often not helpful.

What is anaphylaxis?

Anaphylaxis is a severe, life-threatening allergic reaction. This serious reaction happens within seconds to minutes after you take the drug. With this type of reaction, you may experience:

Swelling of your body parts, with or without hives
Light headedness or dizziness
Sudden drop in your blood pressure, with or without loss of consciousness
Shock, with damage to your internal organs

Anaphylaxis requires emergency treatment to prevent death and damage to your internal organs. Treatment includes:

Drugs (oxygen, adrenalin, antihistamine)
Intravenous fluid

These treatments help support your blood pressure and your internal organs. Your doctor may give you a form of steroids. If you stop breathing, the doctor may give you artificial breathing.

If you take a drug and find yourself in the middle of this type of reaction, you and those around you must act fast. Immediately call your local emergency telephone number (911 in most places in the United States and Canada). Antihistamines might help. Alone, they will not keep you out of serious trouble.

If you carry self-administered epinephrine (adrenalin), then you should take it immediately. If you do carry adrenalin, be sure you really know how and when to use it in an emergency. If you observe someone go into anaphylaxis, then be sure to put the person on their back and raise that person’s feet. Call your local emergency telephone number immediately!

If you have a drug allergy:

Make sure all of your doctors know the drug you took and the drug reactions you suffered
Check with your doctor about related drugs that you must avoid
Check with your doctor about drugs that you can take, if needed
Wear an emergency medical alert bracelet or necklace, with the offending drug engraved

For more information on drug allergy, please visit the following site at the National Institutes of Health: http://www.nlm.nih.gov/medlineplus/ency/article/000819.htm

Dust Allergy

House Dust Allergy

Many people have symptoms such as a runny or stuffy nose, itchy, watery eyes and sneezing from dust exposure related to common household chores such as vacuuming, sweeping, and dusting. House dust exposure can also trigger asthma symptoms such as wheezing, coughing, chest tightness and shortness of breath.

Dust allergy diagnosis

If you think you may have an allergy to any of the components of house dust, come in for an evaluation. To pinpoint the cause of your symptoms, we will ask detailed questions about your work and home environments, family medical history, frequency and severity of symptoms, exposure to pets and a variety of other questions. Sometimes the history will reveal obvious triggers, like someone who develops symptoms every time they are around a certain animal. More often though, the history may suggest triggers, but it may not be obvious in identifying the exact ones.

Sometimes the medical history may not suggest any triggers, yet allergy may be the cause. In this case, we will find out what you are allergic to by doing skin tests. Skin tests involve either pricking the skin or injecting into the skin with different allergens and observing for a reaction.

Dust allergy treatment

Once your allergy triggers have been identified, steps should be taken to avoid them. Research has confirmed that environmental control can be as effective as medications in reducing symptoms. Usually successful treatment requires environmental controls, prescription medications, and in many cases, immunotherapy (allergy shots) to bring the problems under control.

Why does house dust cause allergic reactions?

House dust is a mixture of many substances. Its content varies from home to home, depending on the type of furniture, building materials, presence of pets, moisture and other factors. A speck of dust may contain fabric fibers, human skin particles, animal dander, microscopic creatures called house dust mites, parts of cockroaches, mold spores, bacteria, food particles and other debris. Of these, animal dander, house dust mites and cockroaches are the most common culprits. A person may be allergic to one or more of these substances, and, if exposed to the dust, will have an allergic reaction.

What are house dust mites?

Tiny microscopic creatures called house dust mites are an important cause of allergic reactions to house dust. They belong to the family of eight-legged creatures called arachnids. This family also includes spiders, chiggers and ticks. Dust mites are hardy creatures that live well and multiply easily in warm, humid places.

As many as 10 percent of the general population and (in some regions) 90 percent of people with allergic asthma are sensitive to dust mites. Recent studies in the United States suggest that at least 45 percent of young people with asthma are allergic to dust mites.

Dust mite feces are just the right size to be inhaled. They are found in the highest concentrations in pillows, mattresses, carpeting and upholstered furniture. They float into the air when anyone vacuums, walks on a carpet or disturbs bedding, but settle out of the air once the disturbance is over. A dust mite allergic patient who sleeps for eight hours every night spends one third of his life with his nose in direct contact with a pillow loaded with dust mite feces!

There may be many as 19,000 dust mites in one gram of dust, but usually between 100 to 500 mites live in each gram. (A gram is about the weight of 2 paper clips.) Egg-laying females can add 25 to 30 new mites to the population during their lifetime. Mites eat particles of skin and dander, so they thrive in places where there are people. Dust mites don't bite, and cannot spread diseases. They are harmful only to people who become allergic to them. While usual household insecticides have no effect on dust mites, there are ways that allergic people can reduce exposure to dust mites in the home.

Why is mold present in house dust?

Molds are commonly found in outdoor air, and they come in any time you open a door or window. Any house can develop a mold problem given the right conditions. You might not see it growing on the walls, but it may still be present in your home. Molds require two factors to grow indoors: (1) free moisture that can occur in the form of relative humidity above 50 percent, leakage from pipes or foundations, or any ongoing source of water; and (2) something to grow on. Molds particularly like to grow on wallboard, wood or fabrics, but will grow virtually any place if they are given a chance.

Molds spread by producing spores that can become airborne. These spores end up in house dust where they grow. Dust from mold-contaminated houses can cause allergy symptoms if a mold-sensitive person inhales it.

Does house dust contain cockroaches?

As unappealing as it seems, cockroach particles can be a component of dust. This is most common in older, multifamily housing and in the southern United States where complete extermination of cockroaches is very difficult. It is also present in many public buildings and schools, so exposure may still occur even if there are no roaches at home. Allergic individuals, particularly those with asthma, will tend to have increased symptoms when they go into such houses. Cockroaches require food and moisture to survive, so eliminating sources of each can help reduce exposure. In cockroach endemic areas, the services of a skilled professional exterminator will be required to keep cockroaches under control.

Is house dust allergy seasonal?

Yes. In the United States, dust mite populations tend to peak in July and August, and their allergen levels stay high through December. Mite allergen levels are lowest in late spring. Some dust mite-sensitive people report that their symptoms get worse during the winter. That's because mite fecal particles and pieces of dead mites, both of which trigger dust mite allergy, are still present. Mold levels tend to peak during the summer months depending on where you live since some tropical areas have molds year-round. There is also evidence that cockroaches have a seasonal pattern, peaking in the late summer.

Forced-air heating systems tend to blow dust particles into the air. As they dry out over time, even more of the particles become airborne. This does not account for the seasonal pattern, however, since air blows through the same ducts during the summer when air conditioning is used. People may have fewer symptoms from house-dust exposure during the summer because they spend more time outdoors.

For these reasons, the terms "seasonal allergy" and "perennial allergy" are being used less frequently. It is better to classify symptoms as "intermittent" or "persistent".

Why does house dust cause allergic reactions?

House dust is a mixture of many substances. Its content may vary from home to home, but the most common allergy triggers are:

Dust mites
Cockroaches
Fungi (Mold)
Animals

Any of these allergens can cause a response in the immune system which results in the production of a special antibody (Immunoglobulin E or IgE). IgE brings about an allergic inflammatory response. Exposure to only small amounts of the offending allergen can cause allergy symptoms.

Dust Allergy Management

Tips for reducing house dust allergens.

1. Measure the indoor humidity and keep it below 55 percent. Do not use vaporizers or humidifiers. You may need a dehumidifier. Use vent fans in bathrooms and when cooking to remove moisture. Repair all water leaks.

Excellent references regarding mold prevention and remediation can be found at http://www.epa.gov/mold and http://www.nyc.gov/html/doh/html/epi/moldrpt1.shtml

2. Remove wall-to-wall carpets from the bedroom if possible. Use a central vacuum or a vacuum with a HEPA filter regularly. If you are allergic, wear a N95 filter mask while dusting, sweeping or vacuuming. Remember, it takes over two hours for the dust to settle back down, so if possible clean when the allergic patient is away and don't clean the bedroom at night.

3. Keep pets out of the bedroom at ALL times. Consider using a HEPA Air Cleaner in the bedroom. It is best to remove the animal from the home.

4. Encase mattresses and pillows with "mite-proof" covers. Wash all bed linens regularly using hot water.

5. Do not leave out uncovered food at night. Dispose of food wastes (including fast food wraps) in a tightly sealed garbage can. Use roach traps. Schedule regular professional pest control utilizing integrated pest management (IPM) methods.

6. Install a high efficiency media filter with a MERV rating of 11 or 12 in the furnace and air-conditioning unit. Leave the fan on to create a "whole house" air filter that removes particulates. Change the filter at least every three months (with the change of the seasons) to keep the air cleaner year round. Have your heating and air-conditioning units inspected and serviced every six months.

Is dust allergy a sign of a dirty house?

No. A dirty house can make a house dust allergy problem worse, however. Normal housekeeping may not be enough to get rid of house dust allergies. This is because many of the substances in dust cannot be removed by normal cleaning procedures. Vigorous cleaning methods can actually put more dust into the air making symptoms worse. Even if the house is very clean, some people are so allergic to dust that even minimal exposures may trigger their symptoms.

Eye Allergies

If your eyes itch, are red, tearing or burning, pay attention to what they may be telling you. You may have eye allergies, or allergic conjunctivitis, a condition that affects millions of Americans. It is a condition that can occur alone, but often accompanies nasal allergy symptoms, such as sneezing, sniffling and a stuffy nose. And, while most people treat nasal allergy symptoms, they often ignore their itchy, red, watery eyes. Here you will find answers to common questions and information on eye allergy treatment.

Eye allergy triggers

Allergens that may be present indoors or outdoors can cause eye allergies. The most common outdoor airborne allergens are grass, tree and weed pollens. People who are sensitive to these allergens suffer from seasonal allergic conjunctivitis, the most common type of eye allergy.

Pet hair or dander, dust mites and molds are the most common indoor allergens. These indoor allergens can trigger symptoms for some people throughout the year, resulting in perennial allergic conjunctivitis.

Cigarette smoke, perfume and diesel exhaust may inflame your eyes. They can act as irritants that cause non-allergic symptoms, or they can make your allergic response worse.

Eye allergy causes

Just like hay fever and skin rashes, eye allergies develop when the body's immune system becomes sensitized and overreacts to something that is ordinarily harmless. An allergic reaction can occur whenever that "something" - called an allergen - comes into contact with your eyes. The allergen causes certain cells in the eye (called mast cells) to release histamine and other substances or chemicals that cause blood vessels in the eyes to swell, and the eyes to become itchy, red and watery.

Can eye allergies harm my eyesight?

Eye allergies, specifically allergic conjunctivitis, can be extremely annoying and uncomfortable, and they may disrupt your day-to-day activities, but they usually do not harm your eyes. However, there are rare conditions that are associated with atopic dermatitis (eczema) and other diseases can cause inflammation that may affect the eyesight. Chronic forms of eye allergy may also be caused by application of eye drops and creams, or even cosmetics.

Eye Allergy Symptoms

Eye allergies share symptoms with numerous other eye diseases, making accurate diagnosis imperative. Eye allergy symptoms can range from mildly annoying redness to inflammation severe enough to impair vision.

The four primary types of eye allergy are allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. An allergist can diagnose which type of allergy your child is suffering from and recommend the best treatment.

Allergic Conjunctivitis

Seasonal allergic conjunctivitis (SAC) is by far the most common type of eye allergy. Patients experience symptoms in spring, summer, or fall, depending on the type of plant pollen they react to. Typical symptoms are:

itching
redness
burning
clear watery discharge

The eyelids may be puffy, and people with chronic allergic conjunctivitis may have chronic dark circles under their eyes, called allergic shiners. No pain or fever is present, although bright lights may bother the eyes. SAC symptoms frequently occur along with a runny nose, sneezing and nasal congestion associated with hay fever and other seasonal allergies. The itching may be so bothersome that patients cant help rubbing their eyes constantly, which actually makes symptoms worse and can cause infection.

Perennial allergic conjunctivitis (PAC), as its name implies, occurs year-round. Symptoms are the same as with SAC, but tend to be milder. They are caused by reactions to dust mites, mold, pet dander or other household allergens, rather than pollen.

Vernal Keratoconjunctivitis

Vernal keratoconjunctivitis is a year-round disease, but symptoms may worsen seasonally, and it is a more serious eye allergy than SAC or PAC. This disease primarily occurs in boys and young men, and about 75 percent of patients also have eczema or asthma. Symptoms of this eye allergy include:

itching
significant tearing and production of thick mucus
the feeling of having something in the eye (foreign body sensation)
aversion to light (photophobia)

Left untreated, vernal keratoconjunctivitis can impair vision.

Eye Allergy Treatment

As with any allergy, the first approach for successful management of seasonal or year-round forms of eye allergy should be prevention or avoidance of the allergens that trigger your symptoms. Here are some avoidance tips to reduce exposure to allergens that affect your eyes.

Stay indoors as much as possible when pollen counts are at their peak, usually during the mid-morning and early evening, and when wind is blowing pollens around.
Keep windows closed and use air conditioning in your car and home. Air conditioning units should be kept clean. Avoid using window fans that can draw pollens and molds into the house.
Wear glasses or sunglasses when outdoors to minimize pollen getting into your eyes.
Avoid rubbing eyes, which will only irritate them or make your condition worse.
Reduce dust mite exposure in your home, especially the bedroom. Bedding, particularly pillows, should be encased in "mite-proof" covers. Wash bedding often in hot water (at least 130*F). Keep humidity in your home low (between 30 percent and 50 percent).
Clean floors with a damp rag or mop rather than dry dusting or sweeping.
Wash your hands immediately after petting any animals. Remove and wash clothing after visiting friends with pets.
If you have a pet to which you are allergic, keep it out of your house as much as possible. If the pet must be in the house, keep it out of the bedroom so you are not exposed to animal allergens while you sleep. Close the air ducts to your bedroom if you have forced-air or central heating/cooling. Replace carpeting with hardwood, tile or linoleum that are easier to keep dander free.
Reduce indoor molds caused by high humidity by cleaning bathrooms, kitchens and basements regularly. A dehumidifier can be used to reduce molds, especially in damp, humid places like basements. Make sure the dehumidifier is cleaned often. To clean visible mold in the home, use detergent and a 5 percent bleach solution as directed.

Because many of the allergens that trigger eye allergies are airborne, avoidance is not always possible.

Do allergy shots treat eye allergies?

If avoidance, oral medication and eye drops do not control your symptoms, allergy shots or immunotherapy is an option for relieving eye allergies. Tiny amounts of the allergen are injected with gradually increasing doses over time. The shots can actually keep your body from reacting to the allergens. The treatment takes several months to achieve maximum results and and you may still be required to use medicine.

Medications for treating eye allergies

Over-the-counter eye drops and oral medications are commonly used for short-term relief of some eye allergy symptoms. However, they may not relieve all symptoms, and prolonged use of some OTC eye drops may actually cause your condition to become worse.

Prescription eye drops and oral medications also are used to treat eye allergies. Prescription eye drops provide both short- and long-term targeted relief of eye allergy symptoms, and they can be used to manage eye allergy symptoms in conjunction with an oral antihistamine that might be taken to manage nasal allergy symptoms.

OTC eye drops and medications

Tear Substitutes. Artificial tears can temporarily wash allergens from the eye and also moisten the eyes, which often become dry when red and irritated. These drops, which can be refrigerated to provide additional soothing and comfort, are safe and can be used as often as necessary.
Decongestants-Antihistamines. Decongestants or vasoconstrictors are available as over-the-counter eye drops to reduce the redness associated with eye allergies. (Eye drops containing vasoconstrictors should not be used by anyone with glaucoma.) The decongestant drops are available alone or in conjunction with an antihistamine, which provides additional relief of itching. The drops are weak and must be used frequently (four to six times a day). It is very important not to use these OTC allergy eye drops for more than two to three days. Prolonged use can actually lead to increased swelling and redness that may last even after discontinuing the drops. You may be familiar with this "rebound effect" that occurs when you use decongestant nasal sprays for more than three days, and your nose becomes even more congested than before.
Oral Antihistamines. Oral antihistamines can be mildly effective in relieving the itching associated with eye allergies, however these medications may cause dry eyes and potentially worsen eye allergy symptoms. Also, some OTC versions of these medications can cause side effects such as sedation, excitability, dizziness or disturbed coordination.

Prescription eye drops and medications

Antihistamines. Eye drops that contain antihistamines can reduce the itching, redness and swelling associated with eye allergies. Although antihistamine eye drops provide quick relief, the effect may last only a few hours, and some of these drops need to be used four times a day.
Mast Cell Stabilizers. Mast cell stabilizers are eye drops that prevent the release of histamine and other substances that cause allergy symptoms. The drops must be taken before exposure to an allergen to prevent itching.
Antihistamine/Mast Cell Stabilizers. Some of the newest eye drops have both an antihistamine and a mast cell stabilizing action to treat and prevent eye allergies. They are used twice a day and provide quick and long-lasting relief of itching, redness, tearing and burning.
NSAIDS. Nonsteroidal anti-inflammatory eye drops also are available to relieve itching. These drops may cause stinging or burning when applied and may need to be used four times a day.
Corticosteroids. Steroid eye drops can help treat chronic and severe eye allergy symptoms such as itching, redness and swelling, but continued use of the drops can have side effects, such as a risk of infection, glaucoma and cataracts. Long term treatment with steroids (more than two weeks) should be done only with the supervision of an ophthalmologist.
Nonsedating Oral Antihistamines. Like OTC oral antihistamines, prescription antihistamines can be mildly effective in relieving the itching associated with eye allergies. They do not have the same sedating side effects as OTC antihistamines, but they still can cause dry eyes and worsen symptoms.

Food Allergies

Food allergy symptoms occur most often in babies and children but can appear at any age. Foods that you have eaten for years without problems can cause allergies.

An allergy occurs when something causes your body’s natural defenses to overreact. Some 40-50 million Americans have an allergy of some kind, but food allergies are rare. Up to 4 percent of adults have food allergies.

Food allergy causes:

The body’s natural defense network is called the immune system. It keeps you healthy by fighting off infections and other dangers to good health. Most people have no problem eating many kinds of foods. An allergic reaction occurs when the immune system attacks a specific food or something in a food by mistake. This battle causes:

Blood vessels to swell up,
Smooth muscles to contract, and
Skin areas to become red, itchy and swollen

Why do I have food allergy?

If both your parents have allergies, you have about a 75 percent chance of being allergic. If one of your parents is allergic, or if one of your relatives from either side has allergies, you have a 30-40 percent chance of having some form of allergy yourself. If neither parent has allergy, the chance is only 10-15 percent.

The amounts of a food or a kind of food you eat, and how often you eat, it may be important to why you become food allergic.

Which foods are most likely to cause allergies?

The most common foods causing allergies are:

Someone allergic to a food may also react to related foods. A person allergic to walnuts may also react to pecans. Persons allergic to shrimp may also react to crab and lobster. A person allergic to peanuts may have problems with soy, peas or certain kinds of beans.

Most food allergy patients only react to one or two foods. Someone allergic to pecans may not have to stop eating all nuts.

For additional resources on food allergies, visit the Food Allergy and Anaphylaxis Network. For the Guidelines for the Diagnosis and Management of Food Allergy in the United States visit the National Institute of Allergy and Infectious Diseases.

Food Allergy Symptoms

An allergic reaction to food, often called food allergies, can cause mild to serious symptoms such as:

Some mild food allergy symptoms may be caused by a food sensitivity rather than an allergic reaction. An allergist can help determine if it is a true allergic reaction.

Shellfish, peanuts and tree nuts are the most common food allergens for adults. Milk, eggs, soy, wheat, shellfish, peanuts and tree nuts are the most common food allergens for children.

Food Allergy Testing

If done correctly, skin tests or blood tests are reliable and can assist in ruling in or out food allergy. Some people do test "allergic" to a food (by skin or blood testing) and yet have no symptoms when they eat that food. To confirm test results, you may need a challenge test. This means that you have to eat or drink small portions of a food in increasing amounts over a period of time to see if an allergic reaction occurs. This is usually done under a physician’s supervision.

What foods make me sick? Some people know exactly what food causes their allergy. They eat peanuts or a product with peanut in it and immediately break out in a rash. Others need a doctor’s help in finding the cause. Occasionally, the symptoms show up many hours after they have eaten the food.

Your allergy treatment will typically begin with a complete medical history. We will ask you about:

The symptoms you have after eating the food
How long after eating the food these symptoms occur
How much of the food you had
How often has the reaction occurred
What type of medical treatment, if any, you had
The medical history will also include questions about your diet, your family's medical history, and your home and living area.

These questions are used to find out what is causing your allergy or making your symptoms worse. Allergy to pollen in the air, such as ragweed pollen, can be the cause of the swelling or itching in your mouth and throat if you eat certain foods like melons.

Can special diets help pinpoint the problem?

A special diet can help pinpoint foods causing allergies. You may be asked to keep a daily food diary. It lists all food you eat and medication you take, along with your symptoms for the day.

If only one or two foods seem to cause allergies, you may try avoiding them. In this diet, you do not eat the suspect food at all for one to two weeks. If the allergic symptoms decrease during that period and flare up when you eat the food again, it is very likely the food causing your allergy.

However, which food you should avoid (and for how long) and when you should eat the food again (if ever) should be decided together in consultation with your doctor. You should never try to eat even a small quantity of any food you and your doctor have decided against.

Food Allergy Diagnosis

Diagnosing food allergies can be as complicated as the medical condition itself. Symptoms of food allergy can vary from person to person, and a single individual may not always experience the same symptoms during every reaction. Food allergic reactions can affect the skin, respiratory tract, gastrointestinal tract, and/or cardiovascular system, and people develop food allergies at various ages.

Diagnostic food allergy testing offers clues about the causes of symptoms, but it cannot determine whether someone has a food allergy with absolute certainty without a challenged study. Still, when a food allergy is suspected, it’s critically important to consult with an allergist who can determine which food allergy tests to perform, determine if food allergy exists, and counsel patients on food allergy management once the diagnosis has been established.

To make a diagnosis, we ask detailed questions about the history of allergy symptoms. Be prepared to answer questions about the specific foods and the quantities you consumed, the length of time that it took for symptoms to develop, the symptoms themselves, and how long they lasted. Your doctor will usually order a blood test (such as an ImmunoCAP test) and/or perform a skin prick food allergy tests, which indicate whether food-specific IgE antibodies are present in your body.

While both of these diagnostic tools can signal a food allergy, neither is conclusive. A positive test result to a specific food does not always indicate that a patient will react to that food when it’s eaten. A negative test is more helpful to rule out a food allergy. Neither test, by its level of IgE antibodies or the size of the wheal, necessarily predicts the severity of a food allergic reaction.

Food Allergy Treatment

Once a food allergy is certain, the best treatment is to avoid the food. You need to carefully check ingredient labels of food products. You should learn other names for the food or foods that you and your doctor think it best to avoid to be sure not to eat them.

When you eat out, you should be extra careful. Waiters (and sometimes the kitchen staff) may not always know every dish ingredient on the restaurant’s menu. Sometimes, even walking into a kitchen or an eatery where food is being prepared can cause a dangerous reaction. Vapor may carry extremely small particles that can be harmful.

What if I eat a food I'm allergic to?

You need to have a clear plan of action in case you eat a food you shouldn’t. Place a list of symptoms and your doctor’s instructions for treatment within easy reach in your kitchen. Medications can be very useful in treating many early symptoms of mild food allergies.

If you have had severe allergic reactions, you need to know when and how to give yourself a shot of epinephrine (adrenaline) to treat a severe reaction. You should go to the hospital or call 9-1-1 and arrange for follow-up care when the reaction is severe. Bracelets or necklaces may be worn to quickly alert medical personnel or other caretakers about food allergies.

Will I ever be able to eat these foods again?

Over time, allergies to cow’s milk, eggs and soy may disappear. Allergies to peanuts, tree nuts, fish and shellfish typically last a lifetime. About one-third of children and adults who had food allergies at some point are eventually free from food allergies after very carefully avoiding the foods.

Once you have had a severe, sudden, life-threatening reaction to a certain food you may be advised to never again eat this food. In some very allergic persons, a very small quantity of a food can produce a life-threatening reaction.

Researchers are now studying ways to go beyond today's methods of treating allergies. Food allergy research may soon produce new and better ways to block the body's allergic response by reducing or inhibiting the release of histamine and other chemicals that cause allergic reactions.

Flu Shot and Egg Allergies

People with egg allergy could have a reaction when given the flu vaccine because the vaccine may contain some amount of egg protein. Fortunately, even in individuals with confirmed egg allergy, flu vaccines may be administered under certain conditions by experienced physicians. Most reactions to flu vaccines are not due to egg-allergy.

How common is egg allergy?

Food allergies are more common in children than in adults. The prevalence of egg allergy depends on age and history of allergic disease. It is estimated that egg allergy exists in 1.6 percent of children in the general population, but it is more common in children with other allergies.

Is there a test to determine egg allergy?

The diagnosis of egg allergy is made based upon both clinical history and either the skin prick test or a blood test. As with any suspected food allergy, it is recommended that an allergist help confirm the test results.

Is there any way to administer the flu vaccine to a very high-risk patient who is allergic to egg?

When egg allergy is suspected, patients should be skin tested to the flu vaccine. If the test is positive, the severity of the reaction and the risk/benefits of administering the vaccine should be evaluated. If the flu vaccine is warranted, it can be administered in the office of an allergy specialist who can administer emergency treatment if necessary.

Is there an alternative flu prevention for high-risk people with egg allergy who are unable to take the flu vaccine?

Yes. A high-risk person with suspected egg allergy can use other flu medications within 24 hours of developing flu symptoms. The medication alleviates or prevents the progression of the flu.

Insect Sting Allergy

Experts estimate that 2 million Americans are allergic to insect stings, and many of these individuals are at risk of suffering life-threatening reactions to insect venom.

Insect stings send more than 500,000 Americans to hospital emergency rooms every year, and cause at least 50 known deaths each year.

Insect sting allergy symptoms

Symptoms of a severe insect sting allergic reaction, called "anaphylaxis," may include hives, itchiness, swelling in areas other than the sting site, difficulty breathing, a sharp drop in blood pressure, hoarse voice or swelling of the tongue, dizziness, unconsciousness and cardiac arrest. Reactions such as these require immediate medical attention.

Insect sting allergy treatment

For emergency treatment, patients are prescribed and given instructions on how to use a self-administered epinephrine (adrenaline) kit. A person who has had an allergic reaction to insect sting has a 60 percent chance of having another similar or worse reactions if stung again, and should always have an emergency kit.

Severe allergies may require preventive treatment called venom immunotherapy (or venom allergy shots). It works by introducing gradually increasing doses of purified insect venom, and has been shown to be 97 percent effective in preventing future allergy to insect bites.

Avoiding insect stings

Avoidance tactics are the first line of defense to insect stings. People with allergies to insect stings should:

Avoid walking barefoot in the grass, where stinging insects forage.
Avoid drinking from open soft drink cans, which stinging insects are attracted to and will crawl inside.
Keep food covered when eating outdoors.
Avoid sweet-smelling perfumes, hairsprays and deodorants.
Avoid wearing bright colored clothing with flowery patterns.

Stinging insects such as bees, wasps, hornets and yellow jackets, are most active during late-summer and early-autumn when nest populations can exceed 60,000 insects. These insects occur throughout the United States. Another stinging insect, the fire ant, occurs year-round and infects more than 250 million acres in the southern states.

How Can I Avoid Insect Stings?

Knowing how to avoid stings from fire ants, bees, wasps, hornets and yellow jackets leads to a more enjoyable summer for everyone. Stinging insects are most active during the late spring, summer, and early fall. Insect repellents do not work against stinging insects.

Yellow jackets will nest in the ground and in walls. Hornets and wasps will nest in bushes, trees and on buildings. Use extreme caution when working or playing in these areas. Avoid open garbage cans and exposed food at picnics, which attract yellow jackets. Also, try to reduce the amount of exposed skin when outdoors.

Effective methods for insecticide treatment of fire ant mounds use attractant baits. These baits often contain soybean oil, corn grits combined with chemical agents. The bait is picked up by the worker ants and taken deeper into the mound to the queen. It can take weeks for these insecticides to work.

Avoid wearing sandals or walking barefoot in the grass. Honeybees and bumblebees forage on white clover, a weed that grows in lawns throughout the country.

Never swat at a flying insect. If need be, gently brush it aside or patiently wait for it to leave.

Do not leave drinks in open beverage cans. Stinging insects will crawl inside a can attracted by the sweet beverage.

When eating outdoors, try to keep food covered at all times.

Garbage cans stored outside should be covered with tight-fitting lids.

Avoid sweet-smelling perfumes, hair sprays, colognes and deodorants.

Avoid wearing bright-colored clothing.

Yard work and gardening should be done with caution. Wearing shoes and socks and using work gloves will prevent stings on hands and feet and provide time to get away from an unexpected mound.

Keep window and door screens in good repair. Drive with car windows closed.

Keep prescribed medications handy at all times and follow the attached instructions if you are stung. These medications are for immediate emergency use while en route to a hospital emergency room for observation and further treatment.

Insect Sting Allergy Symptoms

What are symptoms of insect sting allergy?

The most serious reaction to an insect sting is an allergic one. This condition requires immediate medical attention. Symptoms of an allergic reaction may include one or more of the following:

Hives, itching and swelling in areas other than the sting site
Abdominal cramping, vomiting, intense nausea or diarrhea,
Tightness in the chest and difficulty in breathing
Hoarse voice or swelling of the tongue or throat, or difficulty swallowing

An even more severe allergic reaction, or anaphylaxis, can occur within minutes after the sting and may be life-threatening. Symptoms may include:

Dizziness or a sharp drop in blood pressure
Unconsciousness or cardiac arrest
People who have experienced an allergic reaction to an insect sting have a 60 percent chance of a similar or worse reaction if stung again.

What is a normal reaction to an insect sting, and how is it treated?

The severity of an insect sting reaction varies from person to person. A normal reaction will result in pain, swelling and redness confined to the sting site. Simply disinfect the area (washing with soap and water will do) and apply ice to reduce the swelling.

A large local reaction will result in swelling that extends beyond the sting site. For example, a sting on the forearm could result in the entire arm swelling. Although alarming in appearance, this condition is often treated the same as a normal reaction. An unusually painful or very large local reaction may need medical attention. Because this condition may persist for two to three days, antihistamines and corticosteroids are sometimes prescribed to lessen the discomfort.

Fire ants, yellow jackets, hornets and wasps can sting repeatedly. Honeybees have barbed stingers that are left behind in their victim's skin. These stingers are best removed by a scraping action, rather than a pulling motion, to avoid squeezing more venom into the skin.

Almost all people stung by fire ants develop an itchy, localized hive or lump at the sting site, which usually subsides within 30 to 60 minutes. This is followed by a small blister within four hours. This usually appears to become filled with pus-like material by eight to 24 hours. However, what is seen is really dead tissue, and the blister has little chance of being infected unless it is opened. When healed, these lesions may leave scars.

Treatment for fire ant stings is aimed at preventing secondary bacterial infection, which may occur if the pustule is scratched or broken. Clean the blisters with soap and water to prevent secondary infection. Do not break the blister. Topical corticosteroid ointments and oral antihistamines may relieve the itching associated with these reactions.

Insect Sting Allergy Treatment

How are allergic reactions to insect stings treated?

Insect sting allergy is treated in a two-step approach:

1) The first step is the emergency treatment of the symptoms of a serious reaction when they occur;

2) The second step is preventive treatment of the underlying allergy with venom immunotherapy.

Life-threatening allergic reactions can progress very rapidly and require immediate medical attention. Emergency treatment usually includes administration of certain drugs, such as epinephrine, antihistamines, and in some cases, corticosteroids, intravenous fluids, oxygen and other treatments. Once stabilized, these patients sometimes require close observation in the hospital overnight.

Injectable epinephrine for self-administration is often prescribed as emergency rescue medication for treating an allergic reaction. People who have had previous allergic reactions and rely on epinephrine must remember to carry it with them at all times. Also, because one dose may not be enough to reverse the reaction, immediate medical attention following an insect sting is recommended.

What is venom immunotherapy?

The long-term treatment of insect sting allergy is called venom immunotherapy, a highly effective program administered by an allergist-immunologist, which can prevent future allergic reactions to insect stings.

Venom immunotherapy involves administering gradually increasing doses of venom to decrease a patient's sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.

Latex Allergy

In recent years, serious allergic reactions to latex have been more common. In rare cases, these reactions can be fatal. People with allergy to latex should limit or eliminate future exposure to latex products.

People who are at high risk for developing latex allergy include:

Health care workers and others who frequently wear latex gloves
Individuals who have multiple surgical procedures, such as children with spina bifida
Individuals with other allergies, such as hay fever (allergic rhinitis) or allergy to certain foods

Latex allergy symptoms

In most cases, latex allergy develops after many exposures to latex. Latex allergy can cause symptoms of stuffy nose, hives, wheezing and difficulty breathing. The most severe cases can result in anaphylaxis, a very severe allergic reaction that affects many parts of the body all at one time.

Allergic skin problems can occur following direct contact with or latex. Latex Allergy symptoms may include itching, redness and swelling of that part of the skin that touched the item containing latex.

Some skin problems resulting from the use of latex and non-latex gloves are often confused with latex allergy. These local skin problems are not life threatening, but may develop into latex allergy if latex exposure is continued.

Direct physical contact with latex products is not needed to trigger an allergic reaction. Anaphylaxis has resulted from inhaling latex proteins in the air resulting from the powder in the latex glove.

Latex allergy diagnosis

Latex allergy can most often be diagnosed by an allergy blood test. When the blood test is negative, we may be able to perform latex allergy skin testing.

Latex allergy treatment

The best treatment for latex allergy is avoidance. People with severe latex allergy should:

Wear a warning bracelet
Carry a syringe filled with epinephrine (adrenaline) auto-injector for emergency treatment

Health care workers with a history of latex sensitivity who must wear gloves should stop wearing latex gloves, and their co-workers should not use powdered gloves.

Patients with latex allergy are at risk of asthma on exposure to latex-containing aerosols and should try to avoid areas where powdered latex gloves or their products are used.

What is natural rubber latex?

Natural rubber latex comes from a tree, Hevea brasiliensis, found in Africa and Southeast Asia. Natural rubber latex should not be confused with synthetic rubber. Synthetic rubber products, including latex house paints, are not dangerous for people who are allergic to natural rubber latex.

What products contain natural rubber latex?

Latex is a common component of many medical and dental supplies, including disposable gloves, dental dams, airway and intravenous tubing, syringes, stethoscopes, catheters, dressings and bandages.

Latex also is found in many consumer products, including condoms, balloons, athletic shoes, tires, tools, underwear leg and waistbands, rubber toys, baby bottles, nipples and pacifiers.

What triggers the allergic reaction to latex?

When latex allergic individuals come into direct contact with latex, an allergic reaction may follow. Common examples include:

Receiving medical care or dental care from someone wearing latex gloves
Blowing up a latex balloon

What foods are potential problems for people with latex allergy?

Latex allergic people also can have food allergies. The foods causing this problem include: apple, almonds, avocado, banana, carrot, celery, chestnut, hazelnut, kiwi, melons, papaya, pear, raw potato, stone fruits (such as peach, plum and cherry) and tomato.

How can latex allergy be prevented?

People with latex allergy should avoid direct contact with all products and devices that contain latex. Latex allergy problems during dental, medical or surgical procedures can be prevented by warning health care providers about latex allergy before any test or treatment. When latex allergic individuals need medical or dental care, the procedures can be conducted in a latex-free area.

For additional patient information, call the American Latex Allergy Association at (888) 972-5378 or visit:

www.latexallergyresources.org.

Mold Allergy

Indoor Mold Allergy Information

Molds found indoors come from the outdoors. It is possible to see relatively high levels of molds inside if they are high outside. Any house can develop a mold problem given the right conditions. Certain molds, such as Aspergillus and Penicillium are more commonly found indoors. You might not see it growing on the walls, but it may still be present in your home.

Molds require two factors to grow indoors: (1) free moisture from condensation, leakage from pipes or foundations, or any ongoing source of water; and (2) something to grow on that provides them a food source. Molds particularly like to grow on wallboard, damp wood, fabrics, leather, and paper products. They can also grow on concrete or the dirt on windows or window frames. Food products, particularly vegetables, fruits, and breads provide a good place for mold to grow.

Molds spread by producing spores that can become airborne when they are disturbed directly or by air currents. These spores end up on surfaces where they grow. Dust from mold-contaminated houses can cause allergy symptoms if a person who is allergic to the mold inhales them. Some molds produce bad odors. These odors may be irritating (like any strong odors) without actually causing an allergic response.

Pet Allergies

Pet Allergies Information

Nearly half of U.S. households have a dog or cat. Pets provide companionship, security and a sense of comfort. Children often learn responsibility, empathy and lessons about life and death from pets. However, people with allergies should be cautious in deciding what type of pet they can safely bring into their home.

Pet exposure may cause sneezing and wheezing.

It is estimated that about 10 percent of the population may be allergic to animals. Among people with asthma, up to 30 percent have pet allergy symptoms.

Pets can cause problems to allergic patients in several ways. Their dander, or skin flakes, as well as their saliva and urine, can cause an allergic reaction. Animal hair is not considered to be a very significant allergen. However, the hair or fur can collect pollen, dust, mold and other allergens.

Both feathers and the droppings from birds, another common pet, can increase the allergen exposure. The allergic patient should not use feather pillows or down comforters. If a feather pillow is used, it should be encased in plastic. An encasing with a zipper is recommended, so none of the feathers can escape.

Bird droppings can be a source of bacteria, dust, fungi and mold. This also applies to the droppings of other caged pets, such as gerbils, hamsters and mice.

What are the most common pets?

The most common household pets are dogs, cats, birds, hamsters, rabbits, mice, gerbils, rats and guinea pigs. Larger animals such as horses, goats, cows, chickens, ducks and geese, even though kept outdoors, can also cause problems as pets.

The number of pets in the United States is estimated at more than 100,000,000. This large number also increases the likelihood of accidental exposure to animals by the allergic patient when visiting homes, farms, etc.

What pets are recommended for those with animal allergies?

The ideal pet for an allergic patient would be a pet that didnn't have hair or fur, shed dander, or produce excrement that creates allergic problems. Tropical fish are ideal, but very large aquariums could add to the humidity in a room, which could result in an increase of molds and house dust mites.

A frequent misconception is that haired (not furry) "hypoallergenic" animals cause fewer problems. It is the dander (skin scales) that causes the most significant allergic reactions - not the length or amount of hair on the pet. As stated previously, allergens are also found in the pet's saliva and urine. In addition, dogs have been reported to cause acute symptoms of allergic conjunctivitis, or inflammation of the eye, and hay fever after running through fields and then coming back into contact with their owners.

Those pets that are known to cause significant allergic reactions should be removed from the home of the allergic patient to avoid possible progression of symptoms. A "trial" removal of a pet for a few days or even weeks may be of little value since an average of 20 weeks is required for allergen levels to reach levels found in homes without pets. Due to this, it is often easier and more effective to remove the patient from the home to see if the pet is causing symptoms.

What can I do when visiting people with pets if I am allergic?

The approach to visiting households with pets for someone with pet allergies is to take appropriate precautions including administration of medications prior to visitation. We can provide information on medications for your animal allergy, such as antihistamines, nasal sprays, decongestants or appropriate asthma medications.

For patients who have severe symptoms on animal dander exposure, the pet should removed from the house at least day before the visit, and the host household should be cleansed of animal allergen to the extent practical.

Dog Allergy

Does being around dogs make your nose itch? If so, you may be allergic to dogs.

Although fewer humans are allergic to dogs than to cats, dog dander (dead skin cells), saliva, and urine can cause allergic reactions in many people. The hair of furry animals like dogs also can pick up dust, pollen, and other allergens that set off reactions in people even though the hair itself is not an allergen. Pet dander can travel on clothing or reside in carpeting.

Given that at least one dog is present in almost 40 percent of U.S. households, learning how to recognize dog allergy, treat it, and alleviate its recurrence are essential.

Symptoms

For people without allergies, having a friendly dog come up to you to play could be considered a positive thing. However for those who are allergic to dog, it is an altogether different experience. For these individuals, the animals allergens land on facial membranes and cause eyes to itch, tear, and burn and the nose to get stuffy. For people with asthma, pet dander is a common trigger that can cause symptoms to flare up or worsen.

Is There an Allergy-Free Dog?

The desire to keep dogs as pets is so strong that it has perhaps contributed to the notion that there are hypoallergenic dogs, but a truly allergy-free breed does not exist.

The Humane Society of the United States and others contend that Poodles or the Bichon Frise may be less apt to irritate dog-allergic humans, but a recent study found no evidence that so-called hypoallergenic dog breeds produce fewer environmental allergens than other types of dogs. A 2011 study compared dust samples from 173 homes and found no difference in the levels of allergens released by breeds deemed hypoallergenic versus nonhypoallergenic. Some research has suggested that exposure to dogs early in life can protect against allergy development, but the evidence is that there are no dogs free of allergens.

Diagnosis and Treatment

We can help diagnose allergies to dogs, which can be important for families considering adopting or purchasing one as the family pet. Allergy tests using extracts of dog dander from the potential dog or to one of the same breed can be conclusive, although some studies show that factors related to individual dogs may influence allergenicity more than a dogs breed or gender.

For dog allergy sufferers, staying away from dogs is the best way to limit exposure to their allergens and reduce the red eyes and stuffy noses they cause. When outbreaks to dog and other pet allergies do occur, medical treatments vary depending on the symptoms severity and frequency. For example, episodic symptoms may be treated with nose sprays or antihistamine pills. For people with moderate to severe perennial allergic rhinitis (PAR)year-round pet allergies, allergen immunotherapy (shots) can be used Allergy shots gradually improve tolerance to the dog allergen. Bronchodilators may provide temporary relief for people with asthma, but anti-inflammatory therapy such as inhaled steroids, are necessary for nasal and lung symptoms caused by heavy or prolonged exposure.

For owners found to be allergic to dogs who are understandably unwilling to part with a family member, a combination of medications, exposure reduction and shots can be extremely beneficial. Such strategies include restricting the dogs access to certain areas of the household and the use of air filters, frequent and proper housecleaning, and furnishings less likely to harbor allergens.

Cat Allergy

Cats are both beloved pets and a common source of allergens. Up to 25 percent of the population may suffer from cat allergy. And although children of all ages love kittens, parents should know that an estimated 14 percent of children between the ages of six and 19 years old are allergic to cats.

Cat allergy is triggered by allergens found in cat saliva, especially the protein Fel d 1, which cats spread over their bodies when they lick themselves clean. This and other allergens are in dander from the glands in cats fur and skin. Male cats that are not neutered tend to produce large amounts of allergen that stays in the air, is sticky, and lingers in public places. These factors make cat allergies particularly problematic for large numbers of allergy sufferers, even those who do not have a pet cat.

Like dogs, outdoor cats are furry animals and gather dust, pollen, and other allergens that trigger allergic reactions in people, such as wheezing, sneezing, and coughing. Avoiding cat and other pet dander is difficult because it adheres to clothing, carpeting and other furnishings.

Symptoms

Cat allergy is triggered when the animals allergens land on facial membranes and cause eyes to itch, tear, and burn and the nose to get stuffy. When there are low levels of allergens or low sensitivity to them, cat allergy symptoms may take time to appear. In some people, symptoms can be more severe and come on fast, such as when airborne particles get into the lungs, are inhaled, and mix with antibodies. Highly sensitive people can experience severe breathing problems within 15 minutes to 30 minutes and get a rash on the upper chest, neck, and face.

Diagnosis and Treatment

We can help diagnose and treat those who are allergic to cats. Along with the patients medical history, skin-prick tests or blood tests may be used to diagnosis feline allergies.

To treat symptoms, various types of therapies may be used depending on their severity and frequency of those symptoms. Time spent in a cat free environment can gradually improve symptoms. Episodic symptoms like coughing and sneezing may be treated with nose sprays or antihistamine pills. Prolonged exposure could creat inflammation and require a more aggressive approach. If avoidance is impractical, anti-inflammatory medications may be necessary to control symptoms. For those with moderate or severe perennial allergic rhinitis (PAR)year-round pet allergies, allergen immunotherapy allergy shots may be used. Allergy shots gradually improve tolerance to the cat allergen.

Other Defenses

The most effective defense against cat allergies is to avoid cat dander. Yet this is an unrealistic recommendation for the millions of cat-allergy sufferers who do not want to part with their furry companions and because of the persistence of cat dander in the environment.

Cat owners can take steps to reduce overall levels of allergens, including limiting the cats access to bedrooms where people spend most of their time, using air filters, frequent and proper house cleaning, and using furnishings less likely to harbor allergens. Neutering cats as well as bathing and wiping them on a daily basis may decrease owners allergen exposure.

Treating Pet Allergies

Allergy shots for pet allergies

Allergy shots (immunotherapy) may be indicated for cat or dog allergies, particularly when the animal cannot be avoided - as might be the case when the patient is a small animal veterinarian. They are typically given for at least three years and decrease symptoms of asthma and allergy. Usually after about six months of weekly injections allergy symptoms improve and less medication is required.

Allergy shots are most effective and safe when administered under the supervision of an allergist-immunologist. The response is highly individual and depends on environmental avoidance as well as the initial sensitivity of the individual.

Managing pet allergies

If it is not possible or practical to remove the pet, and allergen immunotherapy is not an option it should at least be kept out of the patient's bedroom and, if possible, outdoors. Allergic individuals should not pet, hug or kiss their pets because of the allergens on the animal's fur or saliva.

Indoor pets should be restricted to as few rooms in the home as possible. Isolating the pet to one room, however, will not limit the allergens to that room. Air currents from forced-air heating and air-conditioning will spread the allergens throughout the house. Homes with forced-air heating and/or air-conditioning may be fitted with a central air cleaner. This may remove significant amounts of pet allergens from the home. The air cleaner should be used at least four hours per day.

The use of heating and air-conditioning filters and HEPA (High Efficiency Particulate Arresting) filters as well as vacuuming carpets, cleaning walls and washing the pet with water are all ways of reducing exposure to the pet allergen. Vacuum cleaners with HEPA filters are now available. However, in a patient with severe symptoms resulting from animal dander exposure, a HEPA filter is not an effective solution.

Litter boxes should be placed in an area unconnected to the air supply for the rest of the home, and should be avoided by the allergic patient.

Some allergic patients may have severe reactions, such as wheezing and shortness of breath, after exposure to certain pets. Also, a chronic, slowly progressive feeling of shortness of breath, loss of energy and feeling of fatigue can result from long-term exposure to birds and their droppings. This type of disease is known as hypersensitivity pneumonitis and can result in severe disability. In the event of these severe cases, removal of the offending animal is mandatory.

Rhinitis

Allergic Rhinitis (Hay Fever)

Allergies, including allergic rhinitis, affect an estimated 40 million to 50 million people in the United States. Some allergies may interfere with day-to-day activities or lessen the quality of life.

Rhinitis symptoms

Rhinitis is a term describing the symptoms produced by nasal irritation or inflammation. Symptoms of rhinitis are due to blockage or congestion. They include:

Runny nose
Itching
Sneezing
Stuffy nose due to blockage or congestion

These symptoms are the nose's natural response to inflammation and irritation. They are often associated with itching of the eyes.

The nose normally produces mucus to trap substances (like dust, pollen and pollution) and germs (bacteria and viruses). Mucus flows from the front of the nose and drains down the back of the throat. When too much mucus is made, it can cause a runny nose from the front or post-nasal drip from the back. Cough is the natural response to clearing the throat from post-nasal drip.

Itching, sneezing, and other symptoms can be responses to:

Allergic reactions
Chemical exposures including cigarette smoke
Temperature changes
Infections
Other factors

In most people, nasal congestion goes from side to side of the nose in a cycle several hours long. Some people may notice this nasal cycle more than others, especially if their nasal passages are narrow. Strenuous exercise or changes in head position can affect nasal congestion. Severe congestion can result in facial pressure and pain, as well as dark circles under the eyes.

Rhinitis treatment

When no specific cure is available for your chronic rhinitis, options include ignoring your symptoms, avoiding or decreasing exposure to irritants or allergens to the extent practical, and taking medications for symptom relief.

Once allergic rhinitis is diagnosed, treatment options include avoidance, medication and immunotherapy (allergy shots).

Avoidance - A single ragweed plant may release 1 million pollen grains in just one day. The pollen from ragweed, grasses and trees is so small that the wind may carry it miles from its source. Mold spores, which grow outdoors in fields and on dead leaves, also are everywhere and may outnumber pollen grains in the air even when the pollen season is at its worst.

While it's difficult to escape pollen and molds, here are some ways to lessen exposure.

Keep windows closed and use air-conditioning in the summer, if possible. Automobile air conditioners help, too.
Don't hang clothing outdoors to dry. Pollen may cling to towels and sheets.
The outdoor air usually is most heavily saturated with pollen and mold between 5 a.m. and 10 a.m., so early morning is a good time to limit outdoor activities.
Wear a pollen mask (such as a NIOSH rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.

Medication - When avoidance measures don't control symptoms, medication may be the answer. Medications help to reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms, including tablets, nasal sprays, eye drops and liquids.

What is sinusitis?

Sinusitis is inflammation or infection of any of the four groups of sinus cavities in the skull, which open into the nasal passages. Sinusitis is not the same as rhinitis, although the two may be associated, and their symptoms may be similar. The terms "sinus trouble" or "sinus congestion" are sometimes wrongly used to mean congestion of the nasal passage.

What is allergic rhinitis?

Known to most people as hay fever, allergic rhinitis is a very common medical problem affecting more than 15 percent of adults and children.

Allergic rhinitis takes two different forms:

Seasonal: Symptoms of seasonal allergic rhinitis occur in spring, summer and/or early fall. They are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores.
Perennial: People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by sensitivity to house dust mites, animal dander, cockroaches and/or mold spores. Underlying or hidden food allergies rarely cause perennial nasal symptoms.

Some people may experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. There are also non-allergic causes for rhinitis.

What causes the sneezing, itchy eyes and other symptoms?

When a sensitive person inhales an allergen (allergy-causing substance) like ragweed pollen, the body's immune system reacts abnormally. The allergen binds to allergic antibodies (immunoglobulin E, or IgE) that are attached to cells that produce histamine and other chemicals. The pollen "triggers" these cells in the nasal membranes, causing them to release histamine and the other chemicals. Histamine dilates the small blood vessels of the nose making fluids leak out into other tissues. This causes runny noses, watery eyes, itching, swelling and other allergy symptoms.

Antibodies circulate in the blood stream, and collect in the tissues of the nose and in the skin. This makes it possible to show the presence of these antibodies by skin testing, or less commonly, by a special IgE allergy blood test. A positive skin test mirrors the type of reaction going on in the nose.

No hay, no fever, so why "hay fever"?

"Hay fever" is a century-old term that has come to describe the symptoms of allergic rhinitis, especially when it occurs in the late summer. However, the symptoms are not caused by hay (ragweed is one of the main culprits) and are not accompanied by fever. So, the term "allergic rhinitis" is more accurate. Similarly, springtime symptoms are sometimes called "rose fever," but it's just coincidental that roses are in full-bloom during the grass-pollinating season. Roses and other sweet-smelling, showy flowers rely on bees, not the wind, for pollination. Not much of their pollen gets into the air to cause allergies.

Is there any escape?

A common question from allergic rhinitis sufferers is: Can I move someplace where my allergies will go away? Some allergens are tough to escape. Ragweed, which affects 75 percent of allergic rhinitis sufferers, blankets most of the United States. Less ragweed is found in a band along the West Coast, the southern-most tip of Florida and northern Maine, but it is still present. Even parts of Alaska and Hawaii have a little ragweed.

Allergists seldom recommend moving to another locale as a cure for allergies. A person may escape one allergy to ragweed, for example, only to develop sensitivity to grasses or other allergens in the new location. Since moving can have a disrupting effect on a family financially and emotionally, relocation should be considered only in an extreme situation and only after consultation with an allergist.

Can allergic rhinitis cause other problems?

Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, altered sleep patterns, fatigue, irritability and poor school performance. Occasionally, children may develop altered facial growth and orthodontic problems.

Are all cases of rhinitis caused by allergy?

Rhinitis may result from many causes other than allergy. Not all rhinitis symptoms are the result of allergies. Below are listed the three most common causes of rhinitis with some of their characteristics.

Rhinitis Type	Common Name	Allergic Sensitivity	Causes	Duration Of Symptoms
Allergic	Hay fever	Yes	Dust mites, animals, pollens, molds, cockroaches	Perennial and/or seasonal
Infectious	Colds or flu	No	Viruses	Three to seven days, sometimes longer
Non-allergic	Irritant	No	Smoke, air pollution, exhaust fumes, aerosol sprays, fragrance, paint fumes, etc.	Perennial and/or following exposure

The most common condition causing rhinitis is the common cold, an example of infectious rhinitis. Most infections are relatively short-lived, with symptoms improving at three to seven days. Colds can be caused by any one of more than 200 viruses. Children, particularly young children in school or day care centers, may have from eight to 12 colds each year. Fortunately, the frequency of colds lessens after immunity has been produced from exposure to many viruses.

Colds usually begin with a sensation of congestion, rapidly followed by runny nose and sneezing. Over the next few days, congestion becomes worse, the nasal mucus may become colored, and there may be a slight fever and cough. Cold symptoms go away within a couple of weeks, although a cough may sometimes persist. Cold symptoms that last longer may be due to other causes, such as non-infectious rhinitis or sinusitis.

What are other causes of rhinitis?

Not all hay fever symptoms in the nasal passage are caused by allergy or infection. Similar symptoms can be caused by mechanical blockage, use of certain medications, irritants, temperature changes or other physical factors. In fact, one third or more of people who have year-round nose symptoms do not have allergies. Rhinitis can also be a feature of other diseases and medical conditions.

Drug-induced nasal congestion can be caused by birth control pills and other female hormone preparations, certain blood pressure medications, and prolonged use of over-the-counter decongestant nasal sprays.

Decongestant nasal sprays work quickly and effectively, but they change how the nasal passages normally work. After a few weeks of use, nasal tissues swell after the medication wears off. The only thing that seems to relieve the obstruction is more of the medicine, but the medication's effect lasts shorter lengths of time. Permanent damage to the nasal tissues may result. The medical term for this condition is rhinitis medicamentosa. Consultation with a physician and prescription medication to "get off" the decongestant nasal sprays is often necessary.

What triggers non-allergic rhinitis?

Non-allergic rhinitis, or vasomotor rhinitis, describes a group of other causes of rhinitis, with symptoms not caused by infection or allergy. Many people have recurrent or chronic nasal congestion, excess mucus production, itching, and other nasal symptoms similar to those of allergic rhinitis, but the disorder is not caused by allergy.

Triggers of non-allergic rhinitis include:

Irritants such as cigarette smoke, strong odors and fumes, including perfume, hair spray, other cosmetics, laundry detergents, cleaning solutions, pool chlorine, car exhaust and other air pollution.
Spices used in cooking, alcoholic beverages (particularly beer and wine), aspirin and certain blood pressure medications.
In some people, eating any foods (whether or not they are spicy) can cause nasal drainage because of a non-allergic nerve reflex. The medical term for this is gustatory rhinitis.
Some people are very sensitive to sudden changes in weather or temperature. Skiers often develop a runny nose, but in some people any cold exposure may cause a runny nose. Others start sneezing when leaving a cold, air-conditioned room.

These factors are not allergens, do not induce formation of allergic antibodies, and do not produce positive skin test reactions. Occasionally, one or two positive skin tests may be observed, but they do not match with the history and are not relevant or significant.

The causes of non-allergic rhinitis are not well understood. In high enough concentrations, many odors will cause nasal irritation in almost anyone. Some people are unusually sensitive to irritation and will develop nasal symptoms even when exposed to low concentrations of irritants that do not bother most people.

As is the case with allergic rhinitis, non-allergic rhinitis often can't be cured. Fortunately, symptoms can be kept under control by limiting exposure to substances that cause symptoms and by taking medication when needed. Patients with non-allergic rhinitis should not smoke or permit smoking in their homes.

Dryness of the nasal tissues can be a normal effect of aging, or a characteristic of a nasal condition associated with a foul smelling nasal discharge. Rhinitis can also result from some hormonal factors, such as under-active thyroid or hormone changes during pregnancy. However, pregnancy can either make rhinitis worse or better, or have no effect. Alcoholic beverages can cause the blood vessels in the nose to enlarge temporarily and produce significant nasal congestion.

Hay Fever Treatment

When allergy symptoms are not well controlled with avoidance measures, allergy medications can help to reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms, including oral tablets, liquid medication, nasal sprays, and eye drops.

Intranasal Corticosteroids:

Intranasal corticosteroids are the single most effective drug class for allergic rhinitis treatment. They can significantly reduce nasal congestion as well as sneezing, itching and runny nose. These drugs are frequently prescribed, and are of particular value when rhinitis symptoms are more severe. They are most effective when taken daily, but may have some benefit when taken as needed.

These medications are safe when used under physician supervision. They are designed to avoid the side effects that may occur from steroids when they are taken by mouth or injection. However, care must be taken not to spray them against the center portion of the nose (the nasal septum). The most common side effects are local irritation and nasal bleeding. Some older preparations have been shown to have some effect on children's growth, but data about some newer nasal steroids have not shown an effect on growth.

Antihistamines: Antihistamines are inexpensive and commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms.

Antihistamines do not cure, but help relieve nasal allergy symptoms such as:

Sneezing, itchy, and runny nose
Eye itching, burning, tearing and redness
Itchy skin, hives, and eczema
Certain other allergic conditions.

There are dozens of different antihistamines and wide variations in how patients respond to them. Some are available over-the-counter and others require a prescription.

Generally, the newer (second generation) products work well and produce only minor side effects. Some people find that an antihistamine becomes less effective as the allergy season worsens or their allergies change over time.

Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours. The short-acting antihistamines are often most helpful taken 30 minutes before an anticipated allergic exposure (such as a picnic during ragweed season). Timed-release antihistamines are better suited to chronic (long-term) use for those who need daily medications.

Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms. Many times a patient will say that he "took one, and it didn't work." If he or she had taken the antihistamine regularly for three to four days, and built up blood levels, it might have been effective.

Side effects: Older (first generation) antihistamines may cause drowsiness and/or performance impairment, which can lead to accidents and personal injury. Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day. Impairment can occur even in people who do not feel drowsy. For this reason, it is important that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.

Another frequently encountered side effect is excessive dryness of the mouth, nose and eyes. Less common side effects include restlessness, nervousness, over excitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines.

Alcohol and tranquilizers increase the sedation side effects of antihistamines.

Important precautions:

Never take anyone else's medication.
Do not use more than one antihistamine at a time, unless prescribed.
Keep these medications out of the reach of children.
Know the effect of the medication on you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your "reaction time."
Follow your physician's instructions.

Some antihistamines appear to be safe, but there have not been enough studies to determine absolute safety of antihistamines in pregnancy. Again, consult your allergist or obstetrician if antihistamines must be taken.

While antihistamines have been taken safely by millions of people in the last 50 years, don't take antihistamines before telling your allergist if you are allergic to or intolerant of any medicine; are pregnant or intend to become pregnant while using this medication; are breast feeding; have glaucoma or enlarged prostate; or have any medical illness.

Decongestants: Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistamiic side effects. They do not relieve the other symptoms of allergic rhinitis, such as runny nose, post-nasal drip and sneezing. Decongestants are available as prescription and non-prescription medications and are often seen in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if taking the medication in the afternoon or evening. If this occurs, a dose reduction may be needed.

At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications for the management of emotional or behavioral problems should discuss this with their physicians before using decongestants. Pregnant patients should also check with their physician before starting decongestants.

Non-prescription decongestant nasal sprays work within minutes and last for hours, but should not be used for more than a few days at a time without a physician's order. Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure rhinitis medicamentosa, providing that there is no underlying disorder.

Oral decongestants are found in many over-the-counter and prescription medications, and may be the treatment of choice for nasal congestion. They don't cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you have high blood pressure, you should check with your physician before using them.

Non-prescription saline nasal sprays will help counteract symptoms of dry nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a saline nose spray can be used as often as needed. Sometimes, your physician may recommend washing (douching) of the nasal passage. There are many over the counter preparations for saline rinses, including neti- pots and saline rinse bottles.

Nasal cromolyn is a medication that blocks the body's release of allergy-causing substances. It does not work in all patients. The full dosage is four times daily, and improvement may take several weeks to occur. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to an allergen exposure.

Nasal ipratropium bromide spray (Atrovent) can help reduce nasal drainage from allergic rhinitis or some forms of non-allergic rhinitis.

Montelukast is a tablet medication approved for treatment of allergic rhinitis, as well as asthma. It works against substances called leukotrienes that can cause symptoms of allergic rhinitis.

Antibiotics are for the treatment of bacterial infections. They do not affect the course of uncomplicated common colds and are of no benefit for non-infectious rhinitis, including allergic rhinitis.

Immunotherapy - Allergen immunotherapy, known as "allergy shots," may be recommended for persons who don't respond well to treatment with medications, experience side effects from medications, who have allergen exposure that is unavoidable, or desire a more permanent solution to their allergic problem. Immunotherapy can be very effective in controlling allergic symptoms. Immunotherapy does not help the symptoms produced by non-allergic rhinitis.

Allergy injections are usually given at variable intervals over a period of three to five years. An immunotherapy treatment program consists of injections of a diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then, the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure, and sometimes can actually make skin test reactions disappear. As resistance develops, symptoms should improve, but the improvement from immunotherapy will take several months to occur.

Nasal surgery is of no benefit in allergic rhinitis, but it may help if patients have nasal polyps or chronic sinusitis not responsive to prolonged antibiotics and nasal steroid sprays.

Allergic Diseases and Cognitive Impairment

Sneezing, wheezing, watery eyes and runny nose aren't the only symptoms of allergic diseases. Many people with allergic rhinitis also report feeling "slower" and drowsy. When their allergies are acting up, they have trouble concentrating and remembering.

For instance, allergic rhinitis can be associated with:

Decreased ability to concentrate and function
Activity limitation
Decreased decision-making capacity
Impaired hand-eye coordination
Problems remembering things
Irritability
Sleep disorders
Fatigue
Missed days at work or school
More motor vehicle accidents
More school or work injuries

Many parents of children with allergic rhinitis observe increased bad moods and irritability in their child's behavior during the allergy season. Since children cannot always express their uncomfortable or painful symptoms verbally, they may express their discomfort by acting up at school and at home. In addition, some kids feel that having an allergic disease is a stigma that separates them from other kids.

It is important that the irritability or other symptoms caused by ear, nose or throat trouble are not mistaken for attention deficit disorder. With proper treatment, symptoms can be kept under control and disruptions in learning and behavior can be avoided.

Causes

Experts believe the top two culprits contributing to cognitive impairment of people with allergic rhinitis are sleep interruptions and sedating antihistamine (OTC) medications.

Secondary factors, such as blockage of the Eustachian tube (ear canal), also can cause hearing problems that have a negative impact on learning and comprehension. Constant nose blowing and coughing can interrupt concentration and the learning process, and allergy-related absences can cause people to miss school or work and subsequently fall behind.

Sleep Disruption

Chronic nasal congestion can cause difficulty in breathing, especially at night. Waking is a hard-wired reflex to make you start breathing again. If you have bad allergic rhinitis, you may waken a dozen times a night. Falling back asleep can be difficult, cutting your total number of sleep hours short.

The average person needs about eight hours of sleep per night to function normally the next day. Losing just a few hours of sleep can lead to a significant decrease in your ability to function. Prolonged loss of sleep can cause difficulty in concentration, inability to remember things, and can contribute to automotive accidents. Night after night of interrupted sleep can cause serious decreases in learning ability and performance in school or on the job.

Over-the-Counter Medications

Most allergy therapies don't take into account the effects of allergic rhinitis on mental functioning - they treat the more obvious physical symptoms. Some allergy therapies may even cause some cognitive or mental impairment.

In a recent poll in which allergy sufferers were asked how they treat their symptoms, about 50 percent responded that they use over-the-counter (OTC) medications. The most commonly used OTC medications for allergy symptoms are decongestants and first generation antihistamines, such as diphenhydramine (Benadryl¨) - both of which can cause sleep disturbances.

Decongestants

Decongestants constrict small blood vessels in the nose. This opens the nasal passageways and lets you breathe easier. Some decongestants are available over-the-counter, while higher strength formulas are available with a prescription. In some people, oral decongestants can cause problems with getting to sleep, appetite loss and irritability, which can contribute to allergy problems. If you have any of these symptoms, discuss them with your doctor.

Antihistamines

Antihistamines block the effects of histamine, a chemical produced by the body in response to allergens. Histamine is responsible for the symptoms of allergic rhinitis, including an itchy runny nose, sneezing and itchy eyes. First generation OTC antihistamines available in the United States also can cause drowsiness. Regularly taking OTC antihistamines can lead to a feeling of constant sluggishness, affecting learning, memory and performance.

Newer second generation antihistamines such as Claritin (loratadine) and Zyrtec¨(cetirizine) which are OTC and Clarinex¨ (desloratadine), Allegra(r) (fexofenadine), Xyzal (levocetirizine¨) by prescription are non or low sedating are designed to minimize drowsiness while still blocking the effects of histamine.

Solutions

With all the allergic diseases, the best way to control your symptoms is to avoid coming into contact with your triggers - the substances that cause you to have an allergic reaction. This is often easier said than done. Sometimes it is impossible to avoid the substances that cause symptoms, especially when you are not in control of your environment.

If your allergens can't be avoided, we can help you to create an allergy treatment plan. People who are allergic to indoor things like dust mites or animal dander may need medication on a daily basis, while people who have seasonal symptoms may only need treatment at certain times during the year.

Several types of non-sedating medications are available to help control allergies. One nonsedating nasal spray, NasalCrom (cromolyn), is available without a prescription. Your doctor may also prescribe nasal steroid sprays to treat nasal inflammation. Nasal steroid sprays are highly effective in treating allergy symptoms. The most common side effect associated with nasal sprays is headache.

If medications are not effective or cause unwanted side effects, your doctor may suggest immunotherapy, or "allergy shots". Immunotherapy is used to treat allergy to pollen, ragweed, dust mites, animal dander and other allergens. This process gradually desensitizes you to these substances by changing the way that your body's immune system responds to them. For example, if you are allergic to ragweed, immunotherapy treatments would involve injecting a tiny amount of ragweed pollen extract under your skin every week. Immunotherapy treatments usually last three to five years or longer. Once your body is able to tolerate the substance without producing the symptoms of an allergy, immunotherapy can be stopped, and the need for oral medications should be gone or greatly reduced.

Remember

If allergies are affecting your ability to concentrate or function, several treatment options may be beneficial. Getting allergy symptoms under control can help you sleep at night and function during the day.

If you suspect that you or a family member may have an allergic disorder, make an appointment with your doctor for proper diagnosis. Treating allergies sooner rather than later can help prevent disruptions in learning and behavior.

Sinusitis

Sinusitis Information (Sinus Infection)

Sinus disease is a major health problem. It afflicts 31 million people in the United States. Americans spend more than $1 billion each year on over-the-counter medications to treat it. Sinus disease is responsible for 16 million doctor visits and $150 million spent on prescription medications. People who have allergies, asthma, structural blockages in the nose or sinuses, or people with weak immune systems are at greater risk.

Sinusitis symptoms

A bad cold is often mistaken for sinusitis (sinus disease). Many symptoms are the same, including headache or facial pain, runny nose and nasal congestion. Unlike a cold, sinus disease symptoms may be caused by bacterial infections. It often requires treatment with antibiotics (drugs that kill the germs causing the infection).

Sinusitis diagnosis

If you think you have sinus disease, see your doctor for proper diagnosis. In most cases, sinus disease treatment is easy. By stopping a sinus infection early, you avoid later symptoms and complications.

What is sinusitis?

Sinusitis is an inflammation of the sinuses. It is often caused by bacterial (germ) infection. Sometimes, viruses and fungi (molds) cause it. People with weak immune systems are more likely to develop bacterial or fungal sinusitis. Some people with allergies can have "allergic fungal sinusitis." Acute sinus disease lasts three to eight weeks. Sinus disease lasting longer than eight weeks is considered chronic.

The sinuses are air-filled cavities. They are located:

Within the bony structure of the cheeks
Behind the forehead and eyebrows
On either side of the bridge of the nose
Behind the nose directly in front of the brain

An infection of the sinus cavity close to the brain can be life threatening, if not treated. In rare cases, it can spread to the brain.

Normal sinuses are lined with a thin layer of mucus that traps dust, germs and other particles in the air. Tiny hair-like projections in the sinuses sweep the mucus (and whatever is trapped in it) towards openings that lead to the back of the throat. From there, it slides down to the stomach. This continual process is a normal body function.

Sinus disease stops the normal flow of mucus from the sinuses to the back of the throat. The tiny hair-like "sweepers" become blocked when infections or allergies cause tiny nasal tissues to swell. The swelling traps mucus in the sinuses.

Some people have bodily defects that contribute to sinus disease. The most common of these defects are:

Deformity of the bony partition between the two nasal passages
Nasal polyps (benign nasal growths that contain mucus)
A narrowing of the sinus openings

People with these defects often suffer from chronic sinus disease.

What Are the Symptoms of Sinusitis?

Common symptoms of sinusitis include:

Postnasal drip
Discolored nasal discharge (greenish in color)
Nasal stuffiness or congestion
Tenderness of the face (particularly under the eyes or at the bridge of the nose)
Frontal headaches
Pain in the teeth
Coughing
Fever
Fatigue
Bad breath

Sinus disease is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies.

Allergies can play an important role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.

Asthma also has been linked to chronic sinus disease. Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinus disease that is not caused by infection. Appropriate treatment of sinus disease often improves asthma symptoms.

How is sinusitis diagnosed?

Diagnosis depends on symptoms and requires an examination of the throat, nose and sinuses. Your doctor will look for:

Redness
Swelling of the nasal tissues
Tenderness of the face
Discolored (greenish) nasal discharge
Bad Breath

If sinus disease lasts longer than eight weeks, or if standard antibiotic treatment is not working, a sinus CT scan may help diagnose the problem.

Mucus cultures: If your sinus disease is chronic or has not improved after several rounds of antibiotics, a mucus culture may help to determine what is causing the infection. Most mucus samples are taken from the nose. However, it is sometimes necessary to get mucus (or pus) directly from the sinuses.

Knowing what kind of bacteria is causing the infection can lead to more effective antibiotic therapy. A fungus could also cause your sinus disease. Confirming the presence of fungus is important. Fungal sinusitis needs to be treated with antifungal agents, rather than antibiotics. In addition, some forms of fungal sinus disease—allergic fungal sinusitis, for example—do not respond to antifungal agents and often require the use of oral steroids.

Sinusitis Treatment

Antibiotics

Antibiotics are standard treatments for bacterial sinusitis. Antibiotics are usually taken from 3 to 28 days, depending on the type of antibiotic. Because the sinuses are deep-seated in the bones, and blood supply is limited, longer treatments may be prescribed for people with longer lasting or severe cases.

Overuse and abuse of antibiotics have been causing a major increase in antibiotic resistance. Therefore, patients with sinus symptoms should consider taking an antibiotic only if symptoms (including discolored nasal discharge) persist beyond 7-10 days.

Antibiotics help eliminate sinus disease by attacking the bacteria that cause it, but until the drugs take effect, they do not do much to alleviate symptoms. Some over-the-counter medications can help provide relief.

Nasal decongestant sprays

Topical nasal decongestants can be helpful if used for no more than three to four days. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. Overuse of topical nasal decongestants can result in a dependent condition in which the nasal passages swell shut, called rebound phenomenon.

Antihistamines

Antihistamines block inflammation caused by an allergic reaction so they can help to fight symptoms of allergies that can lead to swollen nasal and sinus passages.

Nasal decongestants and antihistamines

Over-the-counter combination drugs should be used with caution. Some of these drugs contain drying agents that can thicken mucus. Only use them when prescribed by your doctor.

Topical nasal corticosteroids

These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, addressing the biggest problem associated with sinusitis. Topical nasal corticosteroid sprays are also effective in shrinking and preventing the return of nasal polyps. These sprays at the normal dose are not absorbed into the blood stream and could be used over long periods of time without developing "addiction."

Nasal saline washes

Nasal rinses can help clear thickened secretions from the nasal passages.

Surgery

If drug therapies have failed, surgery may be recommended as a last resort. It is usually performed by an otolaryngologist. Anatomical defects are the most common target of surgery.

Skin Allergies

Allergic skin reactions are very common, and it can be difficult to figure out what causes them. There are hundreds of different kinds of rashes that can be caused by many things, such as plants like poison ivy, allergic reactions to a medication or a food, or a response to an illness.

Allergic eczema (atopic dermatitis) and hives (urticaria) are two of the most common skin rashes. Eczema affects 10 percent to 20 percent of children and 1 percent to 3 percent of adults. If you have eczema, your skin may become red, irritated and itchy. Sometimes there are small, fluid-filled bumps that ooze.

Hives are red bumps or welts that appear on the body. About 20 percent of Americans have hives at some time in their lives.

Contact dermatitis is caused when the skin touches either an allergen or something that irritates it, causing symptoms such as a rash, blisters, itching and burning. Most cases of contact dermatitis are not caused by an allergen but by something that irritates the skin such as soap, detergents and some plants.

All About Hives (Urticaria)

Urticaria is another term for "hives." The condition affects an estimated 20 percent of the population at one time or another in their lives. An episode of hives can start as itching, followed by swollen, red welts. The itching may be mild or severe. Scratching, alcoholic beverages, exercise, and emotional stress may worsen the itching.

How long do hives last?

An episode of hives may last from a few minutes to several hours to several days to several weeks. Each individual welt should last no more than 24 hours.

What are the different types of urticaria? Can strep throat cause it?

Acute episodes of urticaria last for six weeks or less. Acute urticaria is generally due to certain foods and additives, medications, insect stings, blood transfusions and infections. Foods such as eggs, nuts and shellfish are common causes of urticaria. Medications such as aspirin and antibiotics (especially penicillin and sulfa) also are common causes of hives. Infections causing hives include the common cold, strep throat, infectious mononucleosis and hepatitis. In most of these cases, when the reason for hives is removed or avoided, the hives resolve.

Chronic episodes of urticaria last more than six weeks. In many cases, the cause of chronic hives cannot be identified despite detailed testing; in this instance the condition is called idiopathic urticaria. In approximately 50 percent of cases of idiopathic urticaria, the immune system is causing the release of chemicals such as histamine. In other cases, chronic urticaria may be associated with thyroid disease or other hormonal problems. Rarely, chronic urticaria has been associated with cancer. In most cases of chronic urticaria, the hives will gradually disappear over time.

Physical urticaria is due to one or more "physical" causes. The most common reason for long-lasting urticaria is dermographism. These hives appear within a few minutes of scratching along an area of skin. Most often, the rash is linear, following the path taken by the act of scratching. Delayed pressure urticaria is swelling that appears on areas of constant pressure from belts and constricting clothing such as sock bands. Cold urticaria (from exposure to low temperature followed by re-warming) can be severe and life threatening if there is a generalized body cooling, for example after a plunge into a swimming pool. Cholinergic urticaria is due to an increase in body temperature with sweating, exercise, hot showers, and/or anxiety. Sun-induced urticaria may occur within a few minutes after exposure to the sun.

Certain types of chronic hives are more painful than itchy. The painful hives may go away leaving a bruise on the skin, and individual hives may last more than 24 hours. In such cases, the cause may be inflammation of the blood vessels (vasculitis).

How are causes of urticaria identified?

In some cases, the cause is obvious – a person eats peanuts or shrimp, and then develops hives within a short time. Because there are so many possible causes for urticaria, other cases require determined detective work on the part of the patient and physician. In some cases, the cause cannot be identified.

A single episode of uncomplicated urticaria does not usually need extensive testing. An episode of hives complicated by swelling or trouble breathing requires immediate evaluation in the emergency room. For uncomplicated urticaria, your physician will evaluate for possible causes. If allergy is suspected, a diary of foods eaten within a few hours before the hives started may be extremely helpful.

Chronic urticaria should be evaluated by an allergist-immunologist. The specialist will take a detailed history about your medical history, your family’s medical history, your work and home environment, and medication you’re taking. In some cases you may need x-rays and/or tests to analyze blood and urine. Allergy skin testing may provide useful information in some cases. Rarely, if food allergies are suspected, skin testing, elimination diet, and/or oral food challenges may be required. When vasculitis is suspected, a skin biopsy may be helpful.

The specific cause of urticaria can be identified in approximately 20 percent of cases. Ongoing research will identify more causes and more effective hives treatments.